HomeMy WebLinkAbout042-1085-30-101
r _
- r,.. r.r::a- ,,:'::~,!•1."=e PRIVATE SEWAGE SYSTEM St. Croix
~Tnry n.: eiulrl^.9 '.nm~: o" Janrsp Ve•nu Nn
INSPECTION REPORT 6600327
GENERAL INFORMATION ir,77A!;'1 TO PFRVIT) smm rlaa :r, v>
cy Undi i,'on-e1LO1' YOB W4v.1C lna'I hr .rnctl Im sttCnddty F4'FJUrF'~ .eC'1 - , S' x'14111: r-i li
".11 Haider 1 Nsc'r GIY J'~ al'"--T xrrliJ 1 Va'cel -ax No
Richard Stout TOWN OF WARREN 042-1085-30-100
Uevnn!^'`^ - $rrfnn:*o.N,:NangelAtoF No
.:S em Pit, I•rsp RLI Elev 131.1
I f' 31.29.18.476A-50
C
TANK INFORMATION ELEVATION DATA
°F L`ANUTACTURFR CAPACI-Y S-A-IIiN RS HI IS LLLY
['I, 7 ?,encnrrara f, i ~ A A
i
to
To I G lot-/
Iloldiny - - SVHl Intel lr
svI c oodet , n
TANK SETBACK INFORMATION
IAt,R,IT)I.W11 N3LDI-
),st htae Ron;, Dl PInletip-
No: o: System / 4 r
I . ,it Grade
PUMPISIPHON INFORMATION
:!a'n.`.ri.l'.c1 - Demand St COvcf
i a°6e CV V
TDP r'I Frici 4r _os: tiy:!rm He»rl TDI! FI ,iz' 7
'ul u•: v:(u' Lerg'P ze te. UV:OSOIL ABSORPTION SYSTEM
RFNrRFNCII 'vYln'^ I _cno• he C! Tlenq .-It DIMENSIONS No U z , nun 1-~W'e l)!Ik
DIM
\ _ ✓Y\`/1
ENSIONS
SFI RACK SYSTI'M TD Pit ULUG IATIL TAKE/,11<ida LEACHING LLfnuldGm'c'~~~~ ta-(W'
INFORMATION - CHAMULR OR
1 yVC (.Y Srstm p q 1 I UNIT M'.d l nun'CCr~
DISTRIBUTION SYSTEM
7,0 --?.1 ,-iAL . r L LwIco U,r 5; c r Hu 1ya.r; Vcr Av Inlaxc
SOIL COVER x pressure Systems Only xx Mound Or At-Grade Systems Only
Ir 11 r Drpl O xr UCp^nl v'cv: 2:od.cc rx Glc^M
1 (.n C...a,-. ~i ItiN I -p F.91e• _ Tol+"-CJ res\ No Yes i::
COMMENTS: FnclHdc code dlscrepenc,es. persons present etr.1 InspP.rllon A1: Inspwicn a2:
Location: No Addlcr:s Ae actable
LI rv1 UM Desurifon
[✓EJC.H>
2) Rdg sewer length= 7 I', ai0 r _ f ✓
amount of cover = r `T
-1n revere RCGUIrLd7 Yes No )ri rT. ~~q
U ' otrn:l std • I:n aaa I m1a, Ir.lon'1a I'rn ✓ t °
C, N.
S1 Safety ana Builainga Divisltx,
0l s i~ GGG I , " 207 W. Washington Ave., P.O. Box 7162
--i
2 8 Madison, WI 53707-7152 r'gm„may pm,n„p®p- (R- filled m by C,
sns 83S i(:), airi W3. ta wdory Cl& soPermit Apr) 59pFpa Sale T-W.O .ber
K 3n a:corCao rF '
p;L,
te9ui M r x to >Mautirg r smitary p•smu Vo¢ ;Lp"rL -..tstme ~.rearoeuad uni; J
s : xPa,v .m inlay and P afesuona S Im p ,mm -`"cw P~µ':~ ar< lubm ned sc. I F gore Address (d&Cacs that m4;lm eodrrssi 1
....~M WO pn,s ;dc may be UW4 for SIN, ndw7
lcTn~ s s:.urdanct w'~ Nc iT.sec~ Lsw 1_J CWI1 / i-, nI SiaCc
L.LPp-ab informatian=Pleye Print All loforroauoo_ ( t
l
Pucr1 k
i "Co) v TG - 6 3 I m
_
Prgserty lastmion
r
:"Y' State
I Coot Phan Ntl9sbU L
m
11 - wc e)
Type of Building-lchrck all ibat-a _ pPl f ia" _ V: k y_ C q, W
4 l a 2 Fain ly Uwe ling Nwnbu of Bwr _ Sa dis On Name -
PubliuC:oomuxASl-I1ear-be Use dR i Bbck~_-
QT`7p1 ~Q ~J Ctt)Of-_.
LJ Sane Onned - (larnbe Use _ _ J CSM Numbs Q yauage of _
L~~ /6+ cTOwn~f_ _
fll. Type afPermit-. (Ch«k only one b on line A. Coin Plete liar B if applicable) - -
Sysrem ~ Rg",,mml synch 7 ?reWrrcaeliolding Tam Rq.lvaaot (A:y I~ CMUr modtf ^aba u, Z-
m& SYes= (exp.autJ
T--
tl. .I 7penal Rrnn.d ~1-jwsir Revi c - ---.~L+t Venom PamrttvMVntvr ad [)aee lsaueC
' Before Espaaum L-l:•in~c ,±f:9nmbc i <]Yamit T:arsfcm New
LN__ Tr ofFOVY[y 5'. stcrNCom -
L _ M..-. ,Y_ _~oenvDevier. ~ (Chec4
L_l !va Ftesnnuxd m (hound C 1lesswicW N-(iround Allende V Mound _ 24 in. of aulable soil f' Mound < 24 gm. Nwitable wd -
I In nm "ank aep )y Z~~~R ~sJ
F . ~ CMet'>-:pcrsW C:rnvpcaem :ex;daio! f' Itmumovt Jev:u : lam
FLA. Ds~~aPfreal nt Area Ioforma(ioo_
.hstpy Fluw (RFdI fh5ld, 1oi1 Applior*M Rani dtl) D - L --C - f / / ' _
~~ispc~aJ lu ca Ruuoed Csf/ Uupersal A.~Pro ~/rtmn Flmaumr
V1. Tank lain CaVecuy in Taal k<I Mr,ufaamc -_."_r_. /
~he..r Tomas Cs~t~s i Gillum UmLG r~ - - ~ ICJ J
- t(~ / r l o_ 3 n~ -
i I l G r
LSepoc ra tawam Tess. N r +~-T A.tL r L _ G > E v[M 'bspa t - L__
VQ. Respoaeibility Statement- f, tl-e a_dIL -
er%,pcd,amaprrapondbdiFy lot mstallao'o oftle POlllN howua the aeacbedd ptan..y
tlu,uaf.anuc T~/W'RS~Nmo B¢smms Phax/NOmbo
Plumber's Ad,kess (Street, Cuy, Stain. Z4 VI bunt_v'Ueparrmenl Llse Unh-`
I - Pamir Fee Ane uce
sod fi"s+ypr?_~x _ Tlasuin em S:gulme
~t~mPc~.e_t s
LX. Coaon~RKTffF ~--i
t s.pltaro Tp~oval
' unvcr:- eI ne c Mare( I r %e /
r'l - 3~ of
AS per ,a gemen'. pl n L l,mnr 0
2 AO sefbr M acure• •.•n m i ' -
~-..-as pea !ypi+: G•r;r. :M--~, i
waa[a m Nlaaleb plain lo, r4 srslaa ace wDm m rk (;omry aaly M NPer ror lews rbo 8 tc s 11 reDes u ve ---J
~Ril-ti396 (lC Il;a}
Soil Test and System PLOI PLAN
I'RO.IE.CT' Rchard Stout ADDRESS 1353 A%VatJkee Tail Hudson W 54016
NE 1!4 NF 1;4+ 31 iT 29 Nilt 18 IV TOWN Warren ComTI SI,CROIX
SYSTEM LLEVATIO\ 99.8!99.p 4.5' below clrade 312618 BEDROOM 3
i DATL
C'ON\'EN't'IOKAL M CON\'EYTIONAL LIFT IIOI,DiNG TANG
1000 gallors LIE'I- TANK SIZE DOSE TAN`F SIZE
MOUND SEPTIC t. NK SIZE
HOLDING TANK SIZE. LOAD RACE J ARSORI'TION AREA 651 0 of chambers 32
RENCInIARK V.R.P. Too of survey iron ASSU\rn ELEVATION loo' Filler 1.ifeUmC biller
BOREHOLE' C WELL - U. R.1'. same as benchmark
70sh Ave
S'"'r Slope
V-,
0' Pio 3 B-]
Bedroom ST
Rouse
Vent
>0- [luick4 Standard
Lf-achino Chamber
of Cover with 20.0 IL of k'ea
SGftn2;pair of end Caps
4' Long
Grade at Sv>tem Elevation
SN' Pmpc•r N I.in AI: piping shal' he ASTNI SDR 30:14. vN:thin
10' of tank, piping shall D_ AS FM F891
wismns'nDeparm»ntof Comme.ce',,, SOIL EVALUATION REPORT Patleof
Division of Safety and Buildings
in aaordencewith Comm B5, N5s Adm Coos "
i C~ ty
Attach compete silo plan on paper not less Man 8 112 x 17 inches m sae Plar rw141
include. W net limited to verecal and horizontal reference point (OMl direction and
percent M". scale or dmensions. north arrow. and location and distanra tons, *00 TZ ~
Please print all information. 79 Retie by _ Date
D.nonw ~Mam«mn,wnv.,W m.y Oe.reJ ra .«m0.n n~, r..n.•' ~~,!u ;;.n;; 3.~ /
Properly Owner !Coe /L W"
C'ovt Lot f V4 r 'id S T N R E (OA w,
Property Owners Maikng Mores Lot a Bco # Subd. Name
I
City Stale Zip Code a Nt,r , ❑ city ❑ VAlage Town Nearest Road
d-New CpnstriNion Use. ' Residential / Number of beMonms - Code denvod drsgn tow rate _ GPD
❑ Replaotinw l ❑ Put4c o commemal - Desrnoe
Parent material _ i ' Hood Rain eievawi if applicable
General mrrrr wft
and rsconntendaeons
System Tylr System Elovaton
F Bonng # Hiatt
m Ground surfaceelev- fl. Depth to Ixrvting factor to Sail Applicatori Rate
Monzon Depth Dominant Culor Redox Desniptdn Texture Structure Consistence Boundary Roots GPDaF
in. Munsel Do Sz. Cord. Color Gr. Sz Sh 'E"'I 'ER#2
i
Boring # El Boring
u Pit Ground sudacs elev. it Depth to timirirg facto _ n Sal hcabon Rate
Hollum Depth Dominant Color Redox Description Texh#e Structure Corsistence Boundary Roots GPDnf
In. Munsell Ou. Sz. Cont. Color Gr Sz. Sh. 'Eff#t -Eff92
r ~
r.
_
Effluent #1 = BOD. > 30 < 220 mpg and TSS >30 < 150 ' Effluent #2 = GOD. < 30 mgt. aril TSS < 30 rig'L
j CST Name (Please Print) ature CST Number
Bird Plumbing, Inc. Shaun Bird _ 226900
Addwss - Dete EvaPaabon Conductotl Tobphone Number
1432 120th St, New Richmond. WI 54017 ' 715-246-4516
I
f'mFn6.: CrnTC: _ FerrP. U F
r-l Bonng n H ?lox;
pit Grourd surlace elito/<
I --:ft. Depth to I Ming factor i n
Soa (cation Rate
r-4 z Depth Dormant Cr" Redox rbarnpann Texture Stature Censstetce Boundary Roots GPDM
In Munset Oct S. Cnrt _Conr Gr. Sz Sh. 'EffN7 'E"2
I~
i
if it
r /a
Atxirg If n Bones
t❑1 pit Gr~sn,9 s. t r v, f - _ _ _ Leoe• to limdng factor in.
_ Sa 4 hcahon Rate
'+onzon Depth Dominant uNor !index Dostzipnon 'er,uro Stricture Consistence Bounddri Roots GPDMi
rn Mansell Ov S< CON Cake ! Gr Sc. Sri
'ERat 'E1fp2
i
I
E] Boring a El Borirg
pit Gruurd sjrfece ekrv m. Depth to Iim ang factor nl.
Soil Application Rate
Horizon 'lepth Dwnlnant Color Redoz Descnpnon Texture Structure Corsstence Boundary Roots GPOM
n. ` Munson Ou. S:. Cane color Cx. Sr. Sh. 'Eflp1 'Eflp2
I
' Effluent got = BOO, > 30 < 220 mqL and TSS >30 < 153 mglL ' EMUera k2 = BOO, < 30 mg& and TSS < 30 rtgiL
The Department of Commerce is an equal opportunity service prav:der and employer. If you need assistance to access services or
reed malarial in an altrrratr fn".'t, pleatr contact thr drpartmrnt at 608-266-3151 or TTY 609-264-~7?7
.
sw~n:m it mo
Ptopert) Owner Parcel ID # Paye -of G Boring # ❑ Boring I 1)-~
Pit Ground surface eiev/ _ ft. DeOM 10 unuMtg tactof / J irt. Solt ication Rate
Horizon Depth Donwtant Coior Redox Desrnoaon Teduwe Sbucu#e C:onsistenoe Boundary Roue .._GPDfIF
Munsel Ou. Sz Cent. Cola Gr. Sz Sh 'E##1 I •Efw7
❑ Pit Ground surface elev. _ tt. ^repln tc limiting fades in.
St% Ao 'I:atTlri Rate
-waon Depth Donrinant Color Redux Description Texture Strumm Consistence BouMary Roo6 GPCN°
I _ ( 'Ett#1 'Eft-,
In. Munaell Du. Sz. Cont. Color i a S2 S',
I
Bonrv ❑ Boring -
Pit Gruund surface elev. t . Dopbt to larxirtg factor
El
Soa Applcaaon Rate
Horizon ')epdu Donunant Col Room Descripaort Texture Structure Consistence Boundary Rar5 GPD#F
m. Munsell Ou. Sz. Cons Color Cx. Sz. Sh. 'EMI 'E##2
I
' Mont V = BOD, >,3() Z2C m94 and TSS -30 < 150 rn,41- ' EMuera #2 • 800, -f 30 "V& and TSS 30 r' g&
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access service or
need material in an alternate format. please contact the department at 008-2W3151 or TTY 608-264-877T
SPI>11J01FbW1
Soil Test and Systern I)LO f PLAN
PRO.]F,CT R,chard Stout ADDRESS 1353 Awatukee Trail Hudson Wi 54016
NF I!4 NE 1M3 31 /-1• 29 N!R 18 W TOWN Warren COUNTY ST.CROIX
SYSTEM ELEV'A'TION 99.8`99.0 4.5' belOW grade 3126!18 BEDROOM 3
DA 1'E.
CONVENTIONAL )00( CONVKNrIONAL LIMP -HOLDING TANK
1000 gallons LIFT TANK SIZE DOSE TANK SIZE.
MOt: Nn sig,TIC TANK SIZI•:
f1O1,0ING TANK SIZE LOAD RATE - 1 ABSORPTION AREA 651 8 of chambers 32
BENCHMARK V.R.r. Top of survey iron ASSUME: ELEVATION We' Filter l.ifChllle 1-ilter
❑BORKHOLE O WELL •ILR.P. sameasbenchmark
_ B.M.*
70th Ave
103. 30'
105' 101'8-2
Vents i
M/ Slope
2-3' X 66' cells With >3' spacing
13-3
70'
i5'
30' 40' IS'
R B-1
Pro 3 12'
Bedroom S.I-
House
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 fQ of Area
5.6ftA2/pair of end caps
4' Lnnp, 1 ` Gradc at System Elevation
34"
839' Property Lin All piping shall be ASTNI SDR 30134, within
10' of tank, piping shall be ASTM F991
- - (elm(, _
/g?%~ 4 } ,1 X18 I Safety anC Buildings Division
201 W Washington Ave., PA. Box 7162 Sa:n:an' oawt Ntmibc (4` be 5iled in. by Ca}
e L sp_t <1 MadivN WI 53707-7162
• ~a\ s ~~j ~D OG~ 3 Z.-]
1 y seF.tMm
Sanitary Perm QS7MRSZM3 /)1 _
3ft~ U. Ad= k -k wbmnsar, 't 4 rJZ a i uW1to
In auordaitt wth S'S `N
rep Prnrv h,JVNincazaanuy Irttru Vim .PPIi a.t.v arcs far sta[e:iwnee r„ rW Yl~lon .tatress (d NHCrnII»n++uf'"v ~`i~
th aw Prn(cssnxul Srv"i 'tr.. oil mfcrmuian sw ptovt'~e tvzl ba us-c I•v .-..rmdaM1' .TTf{,IfLy--. ~x~ / -/~(Ilfi
ae m LYparCn;mc S.dtl)
pU1po5 m s d311Y W11 r tv&'V lau N11 Mm" sw
L Ap cahoaln(ormetio Plele,asee Prrint Ilnformatio _
Propem :1wa-r t N=,- W"I l 7 Pub s
haperiy 0o,,,, "s Madteg Mmes _ -:yep , La~i~+a 3 . a(~. g . y 7 Y A-J
Gust Lot j
City. St•"" Zip Code FMane Nitmbo
- rclc
IL Type of Building (rheck all that ap y) _ . 1 ~ ;ae Y A
ivsiem Name
i of 2 Family Dwcllmr-Nmnbc of Ikd L PA~ YYY p~(- Off! 21 _ ---1
~I PJDII imaac:ul-adenbe Ux
Iy/'rnV~.L C Ciry of
c 51.1 Nmaba n Vdlafe f
Star JwaeA IYS~ibe tine _ / _ s _
nn / ~ Towu of
ll.'I ype of Permit: (CheekopN ooe box no line A. Co line B if lryp
A -DRg-dssmmt S,= It u= :.Id+a c I ] Tfrc Moebbalion V Ex=n SYArm (-P:aml
~'bew System ~ - u July
P
- I`cma I iaaca w New ; ,g l4evsovs ermtt tiumber and i>re l.surW
B. Puma ReocwX n fltmn Knuwn U cwrr r.
Ref,Fepuau tr I (hrner I~-~.'y~a ---rrr( f /j/
RS' v o(POR us 5vetnN('umpmmnt.'Uevice: (C3eck all t pplyl , l~ A
vn>-F9eu1eJ la-0u,mW Ltcs:vcC In-Gr.AUd ] M1'>^,ade Y.autd? 24 n of sunabk set . I MauoC m. T F9t a SoC - I _ S
F. Hcild,rw u~x Vtber l:,sPnsnll ery.~tnr Iexplu J. Ptmuatnem Dente (acplwn). C~tK1MFaG
L - t
V. Ihs mv- real ent Area IoformaLOa
Lcsoo Ka fJ Jspend .VURequved is Dupesai4ro
"ff YxaF
aVSoil AM
,II
yd) ~D_
VT. _
Tank Info Cryacm m I Told t o: MenCaenner
GaBOns _ ` Gellom 'fans < o .c
~Tev Tdn FYaux7auW ~ ~t~~ / ~ ~ ~ - ~ L
1 t
I VII- Respo¢slLdtiv Staten 4 for oadetsepaed, an reFpuunbdity for insnlhma of [k POSYlS xhpwa as the attached PI'^"
Vi Plum~ri',a Vnrc (Pna) T Plum s igmxurc FffIAfPKS?:umbe Buaos acne Nle~ba i .
Fj A beer s Address (Street, CAI-. Ssum. Lp Cc~yf
I VII omom/De artmeat ixl- Oull
-T pr+mi+F'ee-_ Dax socdd lssuut¢ rsip=
owd
,
4 s OD Z no VL Coadi; o e►'1 pp~nva~ - - 1 ~e^ sR""` !
QIPNIWy oA not d :.Idl1' I
as par .1w2 wow? p1m ryu Werl W OUR*&-.
2. IV aMw laC4.am. 01 N I tmaot ua raldt ir"
up IW Pmd"Ol~ eo61 ! 'ffmnsnal. - -
' GYP.. ._-.--ry-.._ aw+ler mnotl e:nti xran:vue<
. .-Allaexb factor Nr.)ttm~yon •wDm0blxeCaua od,mppa
SBD-6398(R :1111)
SysteHt PLOT PLAN
PRoiLcr Richard Stout ADDRESS 1353 Awatukee Tmi', Hudson W 54016
NF ti4 NE 1/4S 3' !T 29 N:R 18 N' TORN Warren cot'NT1' ST. CROIX
SYSTEM ELEVATION 940.'93.5 6' below grade D.ATF. 2,''16 18 BEDROOM 3
CONVENTIONAL. XXX CONVENTIONAL. LIFT HOLDING TAKE
1DOC MOUND SEP'T'IC '1 'ANA SIZE gallons LIFT TANG SIZE DOSE TAKE SILL
HOLDING FANG SIZE LOAD RATE: .7 ABSOItVI [ON AItLA 051 0 oi' chan)hers 32
BENCHMARK V.R.P. Top of Telophone pod ASSUME LLI:VA'I'ION 100' Filter Liic"nnc Filler
❑ BORE11011 O \A'ELL - H. R. P. same as benchmark
70th .Ave
CColo = -
v u i v %'^T" - i V
30' B_M.
1 k1
10'
''9r Slope
fr)' B j
Vcots
90' 1)7.
q_3
'1-3' X 66' ::ells with 3' spacin 100'
S"f
30 Pro 3
Vent Bedroom
Ilouse
A.o Quicka Standar
Leaching ~.~ii.'1 nivi
with 20.0 ft2 of .Area
5.6ft^2/pair of cnd caps _ C;.-adc at SVSlem Elevation
1;39' Proper y Lin All piping shall be ASTM SDR 301:14. '.within
10' of tank. piping shall be AST7M F891
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi54017
715-246-4516
Date: 2/12/18
Owner:Richard Stout
Location: NE1i4 NE1/4 31 T29N.R18W Lot 5 70th Ave
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Leaching Chamber Cross Section
4-6. Maintanance an Contingency Plan
7. Filter Cross Sao'
i
Signature _
Licensecnumber 0226900
System PLOT PLAN
PROJI?CT Richard Stout ADDRESS 1353 Awatukee 1 ,ai' Hudson Wi 54016
NE 114 NE 1/4s 31 1T 29 NIR '8 W Tows Warren COUNTY St. CROIX
SYSITIM F.LEVA'I ION 94.0193.5 6' below grade 2/16(18 BEDROOM 3
DATE CONVENTIONAL XXX CONVENTIONAL. LIFT HOLDING TANK
1000 (gallons LIFT TANK SIZE. DOSE TANK SIZE.
MOUND SF.P77C 'I':\NK SI"!,L
HOLDING 'TANK SIZE LOAD RATE .7 ABSORPTION 1RP:% 651 p of chambers 32
BENCHMARK V.R.P. Top o` Telephone ped ASSC.ME ELEVATION IUU' Filter Lifetime Filter
❑ROREIOLF. O WELL •D.12. P. sameasbenchmark
70th Ave
Scale = 1/4" = 10'
30' B.N1.'
d0' ~
141)'cell, B-I
7" Ic)pc 1116 4
c nls
90' 10' 98'
99'
with >3' spacing 15'
100'
sT
30' Pro 3
Vent Bedroom
House
>6„ Quick4 Standard
of Cover Leaching Chamber
With 20.0 ft2 of Area
5.6ftA2/pair of end caps
Long 12>
Glade at System Elevation
34,.
839' property Lin All piping shall be AS I'M SDR 30134, within
10' of tank, piping Shall be ASTM F891
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 100'
Vent Grade Vent
3' 4 X30/34 Septic Tank 3
Long I 5' S' Lon; t .
Grade at System Elevation
36" GIMLIc at System Elevation
Spacing 5'
2-T X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A-94.0'
B-93.5'
POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page _ of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner -
Aermt f / Septic Tank Capacity r al 13 NA
Septic Tank Manufacturer 0 NA
SIGN PARAMETERS Effluent Filter Manufacturer _ O NA '
Number of Bedrooms -
- O NA Effluent Filter Model C NA
Number of Public Facility Units _CrNA Pump Tank Capacity l 13 NA
Estimated flow (average) - ga Vday Pump Tank Manufacturer NA
Design flow (peak). (Estimated x 1.5) uaI/da Pump Manufacturer NA
Soil Application Rate
~aUdaylR1 Pump Model NA
Standard IrtluenVEflluentOu dy Monthly average' Pretreatment Unit-- - NA
Fats, OR & Grease (FOG) 530 mgtL C Sand/Gravel Filter C Peat Filter
Biochemical Oxygen Demand (BODs) 020 mgrl_ C NA 7 Mechanical Aeration O Watil
Total Suspended Solids (TSS) 5150 mgiL _ 7 Disinfection ❑ Other
I 'Pretreated Effluent Quality Monthly average eisal Cell(s) C NA
Biochemical Oxygen Demand (BODs) s30 mg/L Di Ground (gravity) 0 In Ground (Pressurized)
Tota' Suspended Solids (TSS) 30 mg/L - NA C Al-Grade ❑ Mound
Fecal Cofifonn (geomeirk mean) 510° Cfu/100m1 G Drip-Line 0 Other.
Maximum Effluent Particle Size )6 in dia. ❑ Other ❑ NA
Oaror. - - --i other.-
-N ❑ NA
"Values typical for domestic wastewater and septic tank effluent Other - -
C NA
MAINTENANCE SCHEDULE
Service Event
Service Frequency
inspect condition of tark(s) Al least once every 11 month(s)
ar(s) (Maximum 3years) ❑ VA
Pump out contends of tank(s)- When combined sludge and scum equals vile-third ()S) of tank volume 0 NA
Inspect dispersal ooll(s) At least once every: 0 nionth(s) (Maximum 3 years) C NA
II yea(s)
Q reonth(s}--"-
Clean effluent filler Al least once every: 0 NA
Inspect pump, pump controls & alarm At least once every: C month(s) 0 NA
year(s) _
Flush laterals and pressure test 1 At feast once every: C month(s)
_ 0 year(s) NA
:1 mo
_tZeasit once every--- -
nth(s) NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells slat be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer. POINTS Inspector, POINTS Maintainer; Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to identify any m sling or broken hardware, identify any cracks or leaks, measure the volume of
wmbined sludge and scum and to check for any back up or pending of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface.
.he pending of effluent on the ground surface may incicate a falling condition and requires the immediate notification of the local
,eguletory authority.
NNhen the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent fi tens, mechan.cel or pressuraed components, Pretreatrnent units,
and any servicing at intervals of 512 months, shall be performed by a certified POINTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 aays of completion of any service event.
paw'
START UP AND OPERATION th4t
For new construction. prior to use of the POWTS check treatment tank(s) fix the ~ aR detected s uGS or of attietar contents dheroicharticeb of the
may impede the treatment process and/or damage to dlepersal aM( w9 ham
tank(s) removed boy a s•ptape servicing operator prior to use.
System start up shag not oocu when sot core iorw are frozen at the irtAltrative surface. is teetered the ism wastewater will be
During power outages pump tanks may fill above normal hlgtwater lauds. When Power
discharged to the dispersal cells) in one large dose, overbadng the oell(s) and may result in the bOPeraw W" accap or surface to motoring discharge of @MuMf*
the
PO'Aw to
To avoid this situation ha the, contaft of the pump tank ratirwaved
eflluard pump or contact a kamter or POWTS Maintsmer to assist manually operating the pump controlst $e~~ to motors normal levels
wMMn the pump tank. disturb or CarrhPecL the area rakhln
Dc not drive or part Ydrelas over tanka and dispersal cots. Do not drive or park over, or otherwise
15 fast down slope of any mound or at-grade sag absorption area. fS:
Reduction or elimination of the following from the wastev~er stream may improve the performance aM dised prolong olong the tale we of fou founthe dation d pOWS:
witibiotcs; baby wipes: d waft buts; condoms: cation swabs: degreasers; dental t s~ mdisrJAlona oat rig Pm t
(sharp pump) wafer: fruit and vegetable peelings; gasoline; grasses herbicides;
Pesticides; sanitary napkins; tampons: and water softener bone.
ABANDONIIFM tag be taken to Kure that the system is propefh
When the POWTS fails andW is permanently taken ou of service the foilowehg steps s
and safely abandoned to compliance with chapter Comm 83.33. Wisconsin Administrative Code:
• AN pigng to tanks and Pits shall be disconnected and the abandoned pipe openings settled.
• The owt nts of all tanks and pns stab be removed and property disposed of by a t3eptage Servicing Opaalor.
• After pumper, all tanks and pits stag be etc avated and removed or their covers removed and to void space filled with soil,
gravel or anther iron solid material.
CONTINGENCY PLAN
H the POWTS falls and cannot be repaired the following messures two been, or must be taken. to provide a code compliant
repWc~ system:
fy A nitable replecemam area has been evaluated and may oe uti zed for the location of a replaearrmem soil absorption systern.
The rep4KWWmt area should be protected from disturbonce and compaction and should not be i n> ed p i by requited
setbacks from edstkr and proposed structure, tot lopes and wells. Fawxa to Protect the repleosm' ~ comply with to a rM in
for a new soil and a" evaluation to establish a suitable replacement arm. Replecoment systems ruW
slier at Mat time.
❑ A suitable replacement area is not available due to aeibaek andor soil limimtions. Bamkhg advances in POWTS techndogv a
holding tank may be instated as a last react to replace the failed POWiS.
❑ The site has rot been evaluated to identity a suitable replacement area Upon failure of the POWTS a WO and site evaluation
must be performed to IoCats a suitable replacement eras. If no replaoemhent area is available a holding tw* may be installed as
a lace resat to replace the failed POWrS.
❑ Mound and N-Wa soil absorPtion systems may, be racorwtrhcad in place foliovAng removal of the biomet at the infiltrative
surtax. Reconstructions, of such systems must comply with to rules in effect at that time.
«WARNING3 >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND(OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMMENTS
POWr8INSTALLER POWTS MAINTAINER
Name Name
Phone , Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
PINS Jr it one
P
This aoamerht van drsaed In comO MM wM chapter WS 363.22")(%d)LM and 36354(1). (7) L (3). Wisconsin AQ inistiatus Code.
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ST. CROIX COUNTY
SinyTTC TANK MAINTENANCE AGREEMENT
AND
OWNMHT CERTIFICATION FORM
owner/Buyer
MailingAddress
Ptapcrty Address 3g / 7d u`vL J , I .
Nuffiartiom requited from Planning & Zoning Department fm new constmcbm)
City/Stme Parcel Identification Number
LEGAL DESCRiP'I'ION
Property Location!: V. ' , Sm. _ T NR' W, Town of , ;
Subdivision Lot #
1
Certified Survey Map Volume J Page # v
Warranty Deed # _ J ? Volume ? Page # Spec horse eyes no Lot lip idezmSabW yes! ono
SYSTEM MAINTENANCE AND OWNER CERTTFTCATION
Improper use and mamocnance of your septic system could resin in its yrmamic &ib= to handle wastes. Proper
mainacaama consists of pumping out the septic tank every three years or some, u waded, by a licensed pomper- what you pat into
the syskm can affect the fmrrtion of the septic tank as a treatment stage in the waste disposal system Owner niainteosnce
responsibilitlsc are specified in 4Cti mo. 83.52(1) and in chapter 12 - St. Cron: County Samhry Ordimae.
The property owner agrees to submit to St Croix County Planning At Zoning Department a certification form, signed by the
owner and by a master plumber,.journayman Plumber. restricted Plumbs or a licensed pumper verifying that (1) the on-oft
wastewater disposal system is in ptopa operating condition and/or (2) alter wspoction sod pMVMg (if accessary), the septic tank is
Less than 1/3 furl of sludge.
Uwe, the undersigned have read the above requiramma and agree to maintam the private sewage disposal system with the
standards set forth, ]:mein, as set by the Department of Commerce and the Deportment of Naurrai Reaourou, State of Wiecomsm.
Certification stating that yotm septic system has been maratamed must be completed and :stunned to the St Croix Dignity Planning &
Zing Department within 30 days of the bare you exputition date.
Uwe certify that all shtmtmts on this foon are tmc to the best of myJon knowledge. Vwe am/sre the owner(s) of the
property described above, by vnble-of a w76 deed recorded in Register of Deeds Office,
Number of bedrooms
SK,`NATM OF APPLICANT(S) DATE
""Any mfomu= that is mmepmatred may result in the semary parrot being revoked by the Planning & Zoning Department
Inomde with this apphmtxm a recorded warranty deed from the Register of Deeds Office and a copy of the owti5ed amvey rap if
tefaeaoe is made in the warranty deed
(REV. ON"
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Wisconaxt Department of Ccmirmi SOIL EVALUATION REPORT Page --L of Division of Safety and Buildings
n' arcaxdanrx wfh Comm 85. Wis. ACm. Code
Canty J -
Atiadi complete .,In plan or paper nol less than 0 tit x 11 inches ei s¢e Plan must
imiude, but not limited le •+erucal and nonzontal reference point (BM), 0 r00011 and py.,r, I C ~
Percent slope. style or drmensiors nodhancw andfocauon and distance to near ust road
Please print all, rrTr ev rc Y Date
RMEIVED
aersa.M mipn'ye :v oa u>M'nr onaary P'+rPO><e],P~.aay "a
vv-de mt U.... to 1 fmi
Property Owner 'r Pra ; 1-0,C416011
t
114 4 , b4 5 i I N F. L IOr16h'~_
Property Owner'SMa,ng Address Cl12 ,In L'.7 L1•j1 LotA Blockg
LAY State Zip Code one rr 07 ❑ C-ty ❑ Vibe Nea•r.`sl Road
U New Construction Use Q Res dnnl'ai 1 Wri of twd iw"s Code cenved desgn flow rate " - - GPD
Ej Replacement ❑ Public or commercial Desc'he
Parent material Had Plain elevaeon if apPhcablc
General comments r . - i.4<-~ !'r" . ~'~h') 1i~rF-2C~j
and rewommeindations -
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Selling # Bonn-
0 pit Grrund sunace elev. - h. Depm to l:minrg 'actor
Soil >VI•al an. ate
demon Depth Dominant Cob' Rodox Oosa'phon Texture Structure onnsisen_e Ba I ary Rm's GPD7!
in Afunsell Qu Sz. Cart Cdcr Gr 5. ShEN#•CT^`'
L
R,mng # lCj- Boring
lJ Pit Ground surface efev _ ft. Cep:t, 10 rail g factor coil r Ix2tror Rate
llonion Depth Dominant Color Redox Desuiphon Texture Stmcture Consistence Boundary Kcos GPD-(ft _
n. Munsell Ou. $z Cent Color Gr. Sz. Sh. _ 'Efr#t I 'Etht2
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it
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Effluent #1 = SOD > 30 < 220 nigl and TSS >30 < 150 mg1L ' Effluent V = B:JD < 30 mgtL and TSS < 30 mg/u
CST Nano (Please Pnnl) Signature CST Numpor.
1 _
Address Cale Evaluation Gonduced Telephone Namber
1"0 'I'll
Protmrty Owler _~t-7Pa".1 :DP page
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pit Ground slxlacu elov i~ V ft. Depth to I miung fr..tor 1' _ m
_ Soil /tppligleM Rate
Horizon Depth Dominant COlor RedoA Descoptim fezture Structure Cvisister•ce 6aurfar: Raps GPD.. t
m. Munsell Ou Sz Corl. Colo Gr. Sz Sh. 'En#1 'E4#2
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F1 Bong # Boring --Tiv
U pit Ground surface elev ft Defzh to Emitting factor in.
Soil Applig6p^ Rate
Horizon Depth Dwisnant Color Redoa Description Texture Snc:c'e Consisterce Boundar: Rnols GPO,'R'
c:. Mussel Ou Sz Con. Color Gr. Sz- Sh. 'Eff#1 -Eff#2
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El pit Grounds:^uee'ev. n. Deem to 'nniony'agcr tat.
Soil Appl,wlor. Rate
Homes Dept j Dominant Cola Redo: Cr- pEOn Texture Structure Consistence Boundary Roots GPOtff
in. Munsell Ou. Sz. Cont. Color GI. Sc. 51,. I 'E##1 'En#2
I
EfHUent #I = Bt7D, > 30 220 rrgL and TSS >30 < 150 mq'L ' Effluent #2 = BOD, _ 30 mg/L and TSS s 30 m9fL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 609-266-11 or TTY 609-2(4-9777.
SBD UIQIA 6W I
PropeM Owner 1 ,C{."~' Parcel ID 1; Page - G of
Boring # F1 Brniw
cCr pit Groundsur'aceelev %:-t"•~~' k.. Due¢ U Frl facts LZ D __ir.. Soli Acc+:ca;ie-_~?ac •I
ionzon DeDU,. Dom•ram C aor Reoox Descri Texans Structure ccv..s:smn: e Sounaary Ro0ta GPD.Y
IT). Mvnso' Du S;. colt. color _Gr S: _Sn.
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❑ Bonny k ❑ Baring
-it Grc..rne surface elev. !l. Crz-rim to limang ~aao• in.
1 Sal Apa¢auor Ralell
ionzon ; DeDth Donnranl CAOr Reoox Des;:npUan Torture ! Structure • consistence Boundary Rants CAD41.
I rn Mull Ou. Sz. Coral. eolo• ;r. Sz. St'.. 'Ff #xl 'e=R:
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F boring # F1 Boning
❑ Grotrrntl suaax elce. fl. DupU: to fin:muy factor in.
Sol, .yr natxr. hale
rlorzon Depal Duminan; cobr Reoox DesaiyUw: Texture I Stricture C,o:sis;ance 9uurxrary Ruuts GPD!'f
in. Munseli Du. Sz. cunt. color ' G. Sz Sh *l 'ER#2
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Effluent C' z SOD,> 30 < 220 nl and TSS >30 1150 mg'L ' efl4:enl9, z ROD, <?,0 mc}1 and TSS < 30 mg&
The Department of Commerec :s an equal opportunity service pro.ider and cmDloyet. If you need assistance to ace.ss services or
need material in an altcrnatc format, picric contact the deparrment at n0S-266-34 51 or TTY SOS-2644777.
SaU e1 W (R upy
rwoE _-o•=
LOTH LIE4~L DRSCRIPTION a/+ 'h f T ' N R '.`E(-GF W
NAM K
SCALE:
8M I 1<LLVATION ~
9M I DESCRIPTION ~.~..y.-.~ 1
SM 2 ELEVATION
SM 2 DESCRIPTION
SYSTEM KLEVATIO14
GYETSM TYPE
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fiIONATUR[ DATE
00C`1
Parcel 042-1085-30-100 07~'3 OA 41
AGE 1 OF11
Alt. Parcel 31.29.18-476A-50 042 - TOWN OF WARR:.N
Current X ST. CROIX COUNTY. WISCONSIV
Creation Dale Historical Dale Map # Sales Area Application # Permit # Permit Type # of Units
05102/2012 00 0
Tax Address: Owner(s): 0 - Cun0u1 Cyoer, C = ~;wenl C0.0NITC,
O - ROSCON PROPERTIES I.LC
ROSCON PROPERTIES LL.
1353 AWATUKFE TRL
HUDSON WI 54016
Districts: SC = Schcol SP = Special Property Address(es): Pnme'y
Type Dist # Description
SC 2422 SCH D ST CROIX --EN I RAL
SP 1700 WITC
Legal Description: Acres: 9480 Plat: 5850 CSNt 25-5850 042-2012
SEC 31 T29N R18W NE NE LOT 5 CSM 25-5850 Block/Condo Bldg: LOT 05
Tract(s): (Sec I-wn-Rng 40 114 160 1141
31-29N-18W NE NE
Notes: Parcel History:
RETIRED 042-1085-10-100. CSI 25-5850 Data Doc # VollPage Type
TAKES ALL NFW 1085 30 100. 1085-30-200 05102,'2012 955511 CSM
U4'03/9005 892440 WD
C5M212008 873946 OC
C6i23/2006 828169 WD
2013 SUMMARY Bill Fair Market Value: Assessod with:
0
Valuations: Last Changed: 0311112013
Description Class Acres Land Improve Total State Reason
Totals for 2013:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: o Certification Date: Batch #
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 000 Cco